SCI

[Gina Bolutano]

Hi chrissy,

Ive encountered a question regarding SCI who have shoulder pain from wheelchair mobilty. How do you prevent further pain by adjusting the wheels or rim of the w/c?
The options are: a. More the wheels up/higher b.move it down c.move it forward d. Move it back..

I know its not move it up because it would make the elbow flex more than 120 degrees, is it move it down or forward? Whats the best answer?

Thanks

[Chrissy Durrough Lugge]

Hi Gina,
You would want to move the wheels forward. Moving the wheels forward will improve shoulder biomechanics but also make the wheelchair less stable. This article discusses several aspects of wheelchair configuration, including anterior-posterior axis position of rear wheels: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3944313/

Here is an excerpt from the article:
“The anterior–posterior position of the rear wheels influences two important aspects of wheelchair mobility: stability and manual propulsion. While positioning the wheels rearward improves stability, it limits the user’s ability to reach the handrims in this rearward position, thus reducing the push angle. Alternatively, moving the wheels forward improves propulsion biomechanics but reduces stability. The optimal position of the rear wheels is a client-dependent decision, based on the user’s perception of stability and ease of chair propulsion. However, there are some objective guidelines to support this decision. The rear wheels should be positioned in the most forward position that does not compromise system stability23). Gorce and Louis16) showed that, when moving the rear wheels forward, push angle and shoulder ROM are increased, thus reducing both push frequency and handrim forces, minimizing the risk of upper limb injuries32). In addition to the biomechanical benefits, moving the rear wheels forward diminishes the wheelchair length and, as a result, facilitates turning maneuvers by reducing the rotational inertia of the system24).”

Hope this helps!

Chrissy

[Gina Bolutano]

Thanks so much Chrissy!! This helps a lot. 🙂 Will we still be able to access the journal articles after the exams?

[Chrissy Durrough Lugge]

You will retain access to all the NCS Advantage materials until March 31. Until that time, you can download all the articles and save to a personal device/cloud for access beyond March.

[Kerry Campagnola]

Hi

It looks like they changed the guidelines for documenting zone of partial preservation in 2019. (https://asia-spinalinjury.org/isncsci-2019-revision-released) You would document ZPP for incomplete injuries that have absent DAP vs documenting ZPP for complete injuries ONLY as indicated in the SCI module. Can you confirm that I am interpreting this correctly?
thanks
Kerry

“ZPPs were only defined for complete (ASIA Impairment Scale (AIS) A) injuries with no sensorimotor function in the most caudal sacral segments. Recording ZPPs only in cases with totally lost sensation (absent deep anal pressure (DAP), absent light touch (LT), absent pin prick (PP)) in S4-5 and lost sacral motor function (no voluntary anal contraction (VAC)) is not intuitive and restricts the value of ZPP for effective clinical communication to AIS A lesions only. Therefore, the ZPP rules were modified and are no longer based on the AIS grade. Motor ZPPs are now defined and should be documented in all cases including patients with incomplete injuries with absent VAC. The sensory ZPP on a given side is defined in the absence of sensory function in S4-5 (LT, PP) on this side as long as DAP is not present. This means that in cases with present DAP, sensory ZPPs on both sides are not defined and should be noted as “not applicable (NA)”. In cases with absent DAP, a sensory ZPP can be defined on one side (assuming also absent LT and PP sensation in S4-5 on this side), while it may not necessarily be applicable (and should be noted as ‘NA’) on the other side if there is present LT or PP at S4-5.”

[Chrissy Durrough Lugge]

Hi Kerry,

Thanks for posting this! Yes, I believe you are interpreting this correctly. This revision makes more sense clinically for predicting motor recovery.

Chrissy

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